Objective: To estimate the direct medical costs associated with the treatment of adult patients with obesity in the Russian Federation, including the costs of pharmacotherapy for obesity, management of comorbidities and hospitalizations due to specific obesity-related complication.

Material and methods. A mathematical model was developed to analyze the direct medical costs of pharmacotherapy for obesity and related comorbidities over a 1-year time horizon. The analysis included adults aged 18–69 years with obesity (body mass index (BMI) ≥30 kg/m2); a subgroup of individuals with BMI ≥35 kg/m2 was analyzed separately. The target population size was determined using national epidemiological data, stratified by sex, age, and obesity class. The model evaluated the costs of pharmacotherapy for obesity, management of comorbid conditions, and hospitalizations associated with type 2 diabetes mellitus, coronary heart disease, and arterial hypertension. Treatment costs were calculated based on dosing regimens, the State Register of Maximum Selling Prices, and public procurement data; hospitalization costs were estimated using diagnosis-related groups.

Results. The estimated number of adults with obesity was 21.64 million, including 5.45 million individuals with BMI ≥35 kg/m². In the modeled scenario of universal drug coverage, annual pharmacotherapy costs were estimated at 3.1 trillion rubles for the overall population and 778 billion rubles for the subgroup with BMI ≥35 kg/m². The estimated number of comorbidity cases was 4.44 million for coronary heart disease, 15.2 million for arterial hypertension, and 7.03 million for type 2 diabetes mellitus. Pharmacotherapy costs for these conditions amounted to 69, 324, and 396 billion rubles, respectively. Annual hospitalization costs were estimated at 377 billion rubles for type 2 diabetes mellitus and 89 billion rubles for coronary heart disease.

Conclusion. The management of adults with obesity and comorbid conditions within the Russian healthcare system is associated with substantial direct medical costs. Reducing this burden requires a combination of prevention, early detection, and long-term patient management.

Objeсtive: To evaluate the direct medical costs of treating multiple myeloma (MM) patients with daratumumab and its Russian biosimilar using subcutaneous (SC) and intravenous (IV) administration routes, while considering the patients’ body weights.

Material and methods. The targeted patient population and their weight characteristics were determined according to the MM patients registry at the Hematology Center of Moscow Botkin Multidisciplinary Scientific and Clinical Center. As of February 16, 2026, it included 329 patients treated with daratumumab or its combinations. The costs of a year-long course of therapy were calculated, including the following treatment strategies: daratumumab alone (both SC and IV), a biosimilar alone, or a combination of the two, depending on the patient's weight. Furthermore, cost-minimization and budget impact analyses were conducted within a 1-year timeframe for the considered treatment strategies. These analyses evaluated the direct medical costs of daratumumab therapy based on the dosing regimens outlined in the clinical guidelines and the summary of product characteristics.

Results. The cost-minimization analysis revealed that treatment strategies for MM patients using daratumumab biosimilar alone or in combination (for patients weighing less than 88 kg) with the SC route of the original drug (for patients weighing 88 kg or more) are the most cost-effective. The estimated costs are 4.28 and 4.18 million rubles, respectively, in the first year of treatment and 2.43 and 2.37 million rubles in the second and subsequent years. Meanwhile, solely IV or solely SC administration of the original daratumumab results in a 14.2% and 19.1% increase in costs, respectively, reaching 5.10 and 4.89 million rubles in the first year of therapy and 2.90 and 2.78 million rubles in the second and subsequent years. Also, combining IV and SC forms of the original drug increases costs by 7.8%, reaching 4.62 million rubles in the first year of therapy and 2.62 million rubles in subsequent years. The budget impact analysis revealed that using a daratumumab biosimilar for all patients who received treatment in 2025 would result in total annual savings for the healthcare system of between 701.32 and 1,714.83 million rubles.

Conclusion. Expanding the use of the daratumumab biosimilar is cost-effective, compared not only to the IV form of the original drug but also to the SC form, as well as their combination.

Objective: To conduct a pharmacoeconomic evaluation of the triple beclomethasone/formoterol/glycopyrronium fixed-dose combination (FDC) for the treatment of patients with moderate and severe chronic obstructive pulmonary disease (COPD) in healthcare institutions of the Moscow Region, Russia.

Material and methods. A pharmacoepidemiological analysis was conducted using data from multiple levels of medical care for patients with COPD in the Moscow Region, including records data from the Territorial Fund for Compulsory Health Insurance (TFCHI) and data on subsidized drug provision. To characterize the frequency and structure of inpatient and outpatient care for COPD, a frequency analysis was performed. Direct costs of COPD pharmacotherapy were assessed, including expenditures associated with triple FDCs. In addition, a budget impact analysis was carried out to evaluate the provision of triple FDCs in a single delivery device.

Results. During the analyzed period, 23,583 COPD patients received inpatient care and 7,314 received outpatient care, with total expenditures of 703,329,560 and 251,189,103 rubles, respectively. Analysis of subsidized drug provision showed that 757 patients (4.2% of all patients receiving COPD therapy) were treated with one of three triple FDCs: beclomethasone/glycopyrronium bromide/ formoterol, budesonide/glycopyrronium bromide/formoterol, or vilanterol/umeclidinium bromide/fluticasone furoate. Budget impact analysis demonstrated that two triple FDCs (budesonide/glycopyrronium bromide/formoterol and beclomethasone/glycopyrronium bromide/formoterol) were associated with identical costs: 2,763.20 rubles per month and 33,158.40 rubles per year. Treatment with the vilanterol/umeclidinium bromide/fluticasone furoate combination was associated with higher costs.

Conclusion. Use of triple FDC of beclomethasone/glycopyrronium bromide/formoterol may help improve compliance to therapy among patients with COPD and is associated with lower costs for the Moscow Region healthcare system. This treatment approach is clinically and economically feasible.

Objective: To evaluate the pharmacoeconomic performance of follitropin alfa in women with poor, normal, and high responses to ovarian stimulation in assisted reproductive technology programs.

Material and methods. A pharmacoeconomic evaluation was conducted in women with infertility and an anticipated poor ovarian response undergoing in vitro fertilization, using a cost-minimization analysis. The base-case scenario compared follitropin alfa (Gonal-f® – Merck Serono S.p.A., Italy; Primapur® – IVFarma, Russia) with a fixed-dose combination (FDC) of follitropin alfa/lutropin alfa (Pergoveris® – Merck Serono S.A., Succursale d'Aubonne, Switzerland), all of which are included in the national list of vital and essential drugs. A budget impact analysis was performed for the target population of women with differential ovarian response receiving the FDC in conventional stimulation protocols. In addition, the study compared the cost of a stimulation cycle with follitropin alfa versus the FDC and examined cost differences between biosimilars and originator of follitropin alfa.

Results. In cost-minimization analysis, the mean cost of a stimulation cycle with follitropin alfa was 27–34% lower than that with the FDC, depending on the dosage. The budget impact analysis showed that switching 70% of patients to follitropin alfa reduced total expenditures by 30–33% relative to current practice. This economic advantage was consistent across women with poor, normal, and high ovarian response. In comparative cost analyses, both biosimilars of follitropin alfa were less expensive than the originator formulation.

Conclusion. Use of follitropin alfa, in particular biosimilar formulations, is associated with lower costs than the FDC of follitropin alfa/ lutropin alfa across all evaluated scenarios. These findings support the economic feasibility of incorporating follitropin alfa into assisted reproductive technology programs.

Background. Metastatic and unresectable cutaneous melanoma (MM/uRCM) is an aggressive malignancy associated with high mortality due to its pronounced metastatic potential. Immune checkpoint inhibitors are used to treat MM/uRCM in the Russian Federation. These inhibitors include nivolumab and prolgolimab, which block the programmed cell death 1 (PD-1) receptor. However, there are no direct comparative data on their clinical and economic efficacy and safety as monotherapy, which complicates optimal therapeutic decision-making.

Objective: To evaluate the clinical efficacy and safety of prolgolimab versus nivolumab in MM/uRCM treatment and to conduct cost-effectiveness analysis based on data obtained.

Material and methods. A systematic literature search was conducted in the Embase and PubMed/MEDLINE databases, which identified four clinical trials of prolgolimab and nivolumab in first-line therapy for MM/uRCM. The results were used to perform a matchingadjusted indirect comparison (MAIC) without an anchor. Cox regression and logistic regression were applied for the efficacy and safety analyses, respectively. A cost minimization analysis was carried out using the weight characteristics of 743 Russian patients with MM/uRCM. The analysis only considered the costs of drug therapy. Additionally, the costs of treatment with comparator drugs were evaluated in real-world clinical setting, taking into account therapy discontinuation due to disease progression or patient death. A budget impact analysis was performed for 10 patients with MM/uRCM.

Results. In MAIC, the prolgolimab monotherapy showed no statistically significant differences in overall survival compared to nivolumab after population balancing: hazard ratio (HR) 0.84 (95% confidence interval (CI) 0.47–1.50; p=0.557) in CheckMate 067 trial population; HR 0.89 (95% CI 0.53–1.49; p=0.649) in RELATIVITY-047 trial population. Similarly, for progression-free survival: HR 1.14 (95% CI 0.77–1.70; p=0.511) for CheckMate 067; HR 1.07 (95% CI 0.77–1.48; p=0.683) for RELATIVITY-047. Based on cost minimization analysis results, weighted average annual drug therapy costs for the Russian patient population were 3.98 million rubles for prolgolimab, compared to 5.33 million rubles for nivolumab (34% higher). First-year therapy costs accounting for gradual discontinuation due to progression and death were 2.39 million rubles for prolgolimab versus 3.2 million rubles for nivolumab (difference: 809,559 rubles; 34%). On a five-year horizon, total drug therapy costs were 6.16 million rubles for prolgolimab and 8.25 million rubles for nivolumab. Budget impact analysis revealed a difference in therapy costs for 10 patients with MM/uRCM over a 1-year and 5-year horizons of 13.47 and 20.84 million rubles, respectively. Due to the cost difference, an additional three patients can be treated within the analyzed timeframe.

Conclusion. Prolgolimab monotherapy demonstrated no statistically significant differences in overall survival or progression-free survival compared with nivolumab in MAIC. Given its comparable clinical efficacy and lower cost per treatment course, prolgolimab is cost-effective within the Russian healthcare system and allows for increased patient coverage without additional budget expenditures.

Background. The active ingredient of a new-generation antiviral drug for the treatment of herpes and human papillomavirus infection is alloferon, an oligopeptide with the amino acid sequence HGVSGHGQHGVHG. By inducing interferon biosynthesis, alloferon improves the immune status of men and women with various viral and bacterial-viral infections. The precise mechanism of alloferon's molecular pharmacological action is unknown.

Objective: To establish possible molecular mechanisms of the anti-infective, immunostimulatory, and other effects of alloferon.

Material and methods. Biophysical modeling of the structure and properties of the alloferon oligopeptide and bioinformatic analysis of its amino acid sequence in proteomic databases.

Results. Expert analysis of bioinformatics and biophysical modeling results revealed that the primary hypothesis for alloferon's action is its role as an antigenic epitope, similar in structure to fragments of viral capsid proteins (including hemagglutinin). By interacting with T-cell receptors (TCRs) via major histocompatibility complex (MHC) proteins, alloferon and/or its fragments activate NK lymphocytes, which facilitate the destruction of viral and bacterial pathogens. This mechanism is supported not only by alloferon's similarity to known TCR antigenic epitopes but also by the results of biophysical prediction of epitopes, processing, and binding of alloferon to MHC proteins. The second most significant molecular mechanism involves alloferon's properties as an antimicrobial peptide (AMP) with antiviral activity. This hypothesis is supported by (1) the similarity of the amino acid sequence and amino acid composition of alloferon with known AMPs (piscidins, CA-1, bacteriocin plantaricin, etc.); (2) the potential alpha-helical structure of alloferon; (3) the results of bioinformatics and biophysical prediction of AMP activity against bacterial (E. coli, P. aeruginosa, K. pneumoniae, S. aureus, etc.) and viral (DENV-1, JEV, MERS-CoV, SARS-CoV, SARS-CoV-2, hepatitis C virus, herpes simplex virus) pathogens. Other potentially important molecular mechanisms of action of alloferon include (1) activation of formyl peptide receptors FPR1/2 on the surface of neutrophils (causes chemotaxis of lymphocytes to the site of infection); (2) inhibition of the interleukin-17 receptor (anti-inflammatory effect); (3) blocking the interaction of viruses with sialic acids; (4) cytoprotective properties of peptide fragments within the alloferon molecule; (5) inhibition of proteins containing the potassium channels tetramerization domain (KCTD) (important for modulating neurotransmission and for antitumor activity).

Conclusion. The results of this study indicate verifiable mechanisms of molecular action of alloferon.

Background. No systematic data are currently available on long-term trends in the product range, prices, and supply structure of antithrombotic drugs in the Republic of Uzbekistan, which hinders pharmaceutical supply planning.

Objective:  To conduct a comprehensive analysis of the antithrombotic drug market in the Republic of Uzbekistan covering the period 2010–2024.

Materials and methods. This study presents the first multi-parametric analysis of the antithrombotic drug market in the Republic of Uzbekistan over a 15-year period. The analysis evaluated registration trends, supply volumes, price ranges, manufacturing countries, and the pharmacoeconomic characteristics of antithrombotic agents. Data were obtained from the State Register of Medicines, Medical Devices, and Medical Equipment, published by the Ministry of Health of the Republic of Uzbekistan, as well as the Drugs Audit system. Methodological approaches included product range analysis, trend analysis, price analysis, calculation of the compound annual growth rate (CAGR), and correlation analysis (Pearson correlation coefficient, p<0.05).

Results. The assortment of antithrombotic drugs expanded from 53 to 141 trade names over the period under review, with an average of approximately 50% entering active commercial circulation. Supply volumes increased 6.6-fold, peaking at 12.19 million packages (2020), followed by a decline (CAGR: −8.03%). Although imported products account for 83% of the product range, the share of domestic manufacturers has increased since 2017. The leading International Nonproprietary Names in the market include acetylsalicylic acid, enoxaparin, and clopidogrel; the market share of rivaroxaban is growing.

Conclusion. The antithrombotic drug market in the Republic of Uzbekistan has become more diversified, yet it remains import-dependent. The findings of this study can be used to inform public policy and procurement planning.

Background. Underreporting of adverse drug reactions is a pressing public health concern in the Russian Federation. Addressing this requires evaluating the pharmacovigilance system performance, analyzing stakeholder involvement (patients, healthcare and pharmaceutical professionals, and industry representatives), and refining existing approaches through the enhancement of interagency cooperation and digital solutions.

Objective: To assess the role and level of involvement of pharmaceutical professionals in the spontaneous reporting system of the Russian Federation, identify the primary barriers hindering their participation, and determine areas for improving pharmacovigilance.

Materials and methods. The study analyzes public statistical data from regulatory agencies in the Russian Federation (Roszdravnadzor), the United States (FAERS), and Germany (BfArM) to compare the reporting profiles of key groups. Due to the lack of aggregated national data for the Russian Federation, the authors conducted a survey in 2025 via the Yandex Forms platform, involving 101 respondents (consumers, healthcare professionals, and pharmaceutical professionals).

Results. The study analyzed the causes of underreporting across all target groups, evaluating awareness levels, reporting tool availability, motivation, and other contributing factors. A pronounced imbalance was identified in the Russian reporting system: unlike the multi-channel models of the United States and Germany, the majority of reports in the Russian Federation are submitted by healthcare professionals. The conducted survey revealed that pharmaceutical professionals account for only 8% of reports, which is inconsistent with their legal obligations. Healthcare professionals were found to be the primary contributors (61%), followed by pharmaceutical companies (17%) and patients or their relatives (14%). Notably, despite high pharmacovigilance awareness (88.9%), only 40.7% of pharmaceutical professionals reported encountering consumer complaints. Their preferred method of report submission is direct communication with pharmaceutical companies (51.9%), with online reporting forms being the most convenient format (51.9%). Analysis of comments identified key barriers, including insufficient feedback, procedural uncertainty, and a lack of confidence regarding the effectiveness of reports.

Conclusion. The study identified key problem areas and proposed strategies for improving the pharmacovigilance system in the Russian Federation. Pharmaceutical professionals represent a critical but under-involved category of reporters within the pharmacovigilance system. Improving the completeness and quality of drug safety data requires a comprehensive approach, encompassing educational reform, implementation of digital tools to streamline reporting, and the launch of awareness campaigns. Furthermore, it is essential to foster an environment where reporting adverse reactions is perceived as an integral part of professional responsibility.

Objective: To develop and validate a method for evaluating the economic efficiency of target disease (TD) diagnostics performed via artificial intelligence (AI)-assisted multi-stage patient routing.

Material and methods. The evaluation method was developed through a simulation of two diagnostic routing scenarios (with and without AI program output) based on data from 381 patients with malignant and benign skin neoplasms. This approach was validated using output of the Derma Onko Check AI program, employing previously proposed diagnostic algorithms for melanocytic skin tumors (n=230) at a 62% routing threshold. Formulas were derived to calculate the financial cost (FC) ratio, the cost of identifying one TD case, and coefficients for avoidable and potential avoidable costs to enable mapping within a quadrant matrix. The evaluation method factors in not only the avoidable costs of medical interventions but also the potential avoidable costs (losses) resulting from delayed TD detection.

Results. The implementation of diagnostic algorithms based on the output of the Derma Onko Check AI program demonstrated high economic efficiency. The FC ratio of 0.49 indicates a 51% reduction in the total FCs for melanocytic skin tumors compared to conventional diagnostics. The analysis of avoidable and potential avoidable costs revealed a 59.0% decrease in avoidable costs (R_TC_AC=0.41) and a 51.0% decrease in potential avoidable costs (R_TC_PAC=0.49). These results fall within the optimal efficiency zone of the quadrant matrix.

Conclusion. The obtained results validate factoring missed-case treatment costs into both parts of the R_TC formula. Thisensures accurate comparability of diagnostic approaches with different FC structures and clinical outcomes.

Background. The rapid development of digital technologies and the increasing recognition of real‑world evidence (RWE) underscore the need for its broader integration in comprehensive drug assessment, including the development of national restrictive lists of drugs). In this context, an analysis of the availability of local (Russian) real‑world studies (RWS) and their use in comprehensive drug assessment is highly relevant.

Objective: To analyze the availability of RWE and the frequency of its use in comprehensive drug assessment.

Material and methods. The availability of RWS was assessed for 172 drug proposals for inclusion in national restrictive lists between 2020 and 2024. The study was conducted by calculating the proportion of proposals, for which publications reporting the results of local RWS were available at the time of submission. RWS were identified through a systematic search. The frequency of RWE use in comprehensive drug assessment was evaluated through a content analysis of 28 drug dossiers submitted for inclusion in 2022. The frequency of RWE use was also determined in published cost-effectiveness analyses (CEAs) and budget impact analyses (BIAs) of drugs proposed for inclusion in 2018–2024 (116 publications).

Results. Over the period from 2020 to 2024, local RWS were published for 34% of drugs proposed for inclusion in the national restrictive lists. In 2022, 86% of drug dossiers included RWS. Among the published CEAs and BIAs submitted in 2018–2024, RWE was used in 42% and 63% of cases, respectively.

Conclusions. Russian RWS can already be regarded as a promising source of evidence for comprehensive drug assessment. At the same time, the relatively low publication rate of local RWS indicates the need to further accelerate the generation of such evidence. The high demand for RWE in comprehensive drug assessment underscores the importance of its integration in the development of national restrictive drug lists.

Background. Many pharmaceuticals, including antibiotics, diuretics, some antitumor agents, hormones, etc., can promote the depletion of magnesium (Mg), pyridoxine (vitamin B6, VB6), and other micronutrients (MNs) in the body. This process may lead to the development of hypomagnesemia and concomitant MN deficiencies, which are associated with a range of adverse effects, including neurotoxicity, cardiotoxicity, hepatotoxicity, etc. Moreover, the resulting micronutrient deficiency (MND) may paradoxically aggravate the underlying pathophysiological mechanisms of the diseases for which these drugs are prescribed, thereby potentially diminishing therapeutic efficacy and contributing to treatment-related complication.

Objective: Chemoreactomic assessment of anti-micronutrient (anti-MN) effects of all drugs included in the Anatomical Therapeutic Chemical (ATC) classification system.

Material and methods. Using modern data mining techniques, including mathematical approaches from topological data analysis, labeled graph theory (chemographs), and related method, this study performed a systematic computer-based analysis of databases describing the Mg-depleting effects of drugs; original algorithms for numerically predicting the Mg- and VB6-removing effects of drugs. Original algorithms were developed for the numerical prediction of Mg- and VB6-depleting properties of drugs, as well as for the assessment of other anti-MN effects. These algorithms were subsequently applied in a chemoreactomic screening of 2,527 drugs classified within the ATC system.

Results. A database describing anti-MN properties of drugs was created for 24 MN balance indicators for 18 MNs. Algorithms for predicting the anti-MN properties of drugs were developed with a classification accuracy of 92±10% in cross-validation (the accuracy of predicting VB6 MND – 88%, Mg MND – 94-98%). On average, each drug from the ATC group accounts for 8.5±6.5 anti-MN effects. Only 100 out of 2527 (4%) drugs did not exhibit a negative impact on MN, primarily amino acids, MNs themselves, and choline drugs. The most pronounced negative impact of the drugs under study was related to the metabolism of vitamin D3 (505 ATC categories), VB6 (475 ATC categories), iron (419 ATC categories), vitamin B1 (386 ATC categories), and Mg (375 ATC categories). VB6 MND was caused by 1701 drugs, Mg MND – by 1064 drugs. Antibiotics for systemic use (ATC code J01), psycholeptics (N05) and psychoanaleptics (N06), antineoplastic agents (L01), sex hormones and modulators of the reproductive system (G03), analgesics (N02), antidepressants (N06A), diuretics (C03), antihistamines for systemic use (R06A), anti-inflammatory and antirheumatic agents (M01), direct-acting antivirals (J05A), and antiepileptic agents (N03A) were found to affect adversely the homeostasis of both Mg and VB6. A detailed description of the anti-Mg and anti-VB6 properties of these drug classes was provided. The data obtained via chemoreactomic analysis were compared with that obtained by experimental and clinical studies of Mg and VB6 preparations.

Conclusion. The conducted chemoreactomic analysis provides a substantiated basis for supporting pharmacotherapy with selected medicinal preparations based on organic salts of Mg and VB6.

Objective: To develop and validate a method for evaluating the regional economic efficiency of integrating artificial intelligence (AI) into target disease (TD) detection compared to conventional diagnostics.

Material and methods. Medical data from 381 patients with skin neoplasms (291 benign and 90 malignant cases) were analyzed to develop and validate a method of economic efficiency evaluation. Two diagnostic routing scenarios were simulated: AI-assisted routing (62% threshold) and conventional three-stage routing without AI. The assessment involved calculating financial costs per each identified TD case and for all its cases in the region.

Results. With the use of the Derma Onko Check AI program, the proportion of unreasonable referrals decreased from 40.6% to 6.9% for dermatologists/venereologists and from 22% to 7.6% for oncologists. Calculations performed using the developed method show that unreasonable financial costs per TD case (C43 skin melanoma) in the Moscow Region amounted to 282,268.98 rubles with the use of AI compared to 579,069.26 rubles with conventional diagnostics. The ratio of reasonable to unreasonable costs was 1.7 with the use of the AI (indicating a predominance of reasonable costs) and 0.31 without AI (where unreasonable costs exceed reasonable costs). When extrapolated to the regional level (Moscow, 1470 cases of skin melanoma in 2024), the potential reduction in unreasonable costs amounts to 436,296,411.6 rubles.

Conclusion. Using skin melanoma as an example, the developed method demonstrated the high economic efficiency of integrating AI into TD diagnostics. This technology provides a means to optimize patient routing, reduce the financial burden on the healthcare system, and ensure earlier detection of socially significant diseases. This method can be adapted to evaluate the economic efficiency of AI integration in diagnosis of other pathologies.

Background. In Russia, one of the key mechanisms for ensuring access to modern drug therapy for patients with severe chronic and rare diseases is the federal drug provision program for 14 High-Cost Nosologies (HCN).

Objective: To evaluate the current performance of the 14 HCN program from the perspective of healthcare professionals directly involved in its implementation and to identify priority areas for program improvement.

Material and methods. A survey was administered to specialists responsible for drug provision within the 14 HCN program. The questionnaire included nine questions using interval and ordinal response scales. Of 87 questionnaires received, 28 valid responses were included in the final analysis. Instrument reliability was assessed using Cronbach’s α coefficient, and agreement among expert judgments was evaluated using Kendall’s coefficient of concordance (W) and Pearson’s χ² test.

Results. The questionnaire demonstrated satisfactory internal consistency (α=0.799). According to respondents, the most critical challenges of the program were insufficient funding (mean score 4.29), the need to improve the drug provision system (4.21), and the need to automate the submission and review of applications for medicinal products (4.18). Moderate agreement among experts was observed only in ranking nosologies by priority for implementing improvement measures (W=0.3089). Hemophilia, multiple sclerosis, and malignant neoplasms of lymphoid, hematopoietic, and related tissues were identified as the highest-priority conditions.

Conclusion. The findings confirm need to strengthen the 14 HCN program and may inform the development of organizational and pharmacoeconomic optimization strategies.

Objective: To demonstrate the financialandclinicalvalue of ABC/VENanalysisforevaluating the rationalityofresource allocation underbudgetary constraints.

Material and methods. Data from the inventory and expenditure records of a psychiatric facility for the period 2022–2024 were analyzed. Pharmaceutical expenditures were calculated (ABC-analysis), and rational medicine use was assessed (VEN-analysis). The categories and structure of expenditures were evaluated using ABC/VEN matrix analysis. Spearman’s correlation coefficient and an optimization coefficient were calculated to determine the relationships between variables and evaluate the rationality of resource allocation in terms of the alignment of expenditures with clinical significance.

Results. During the analyzed period, the share of Category I expenditures increased both in terms of the number of subcategories (from 57.9% to 86.66%) and costs (from 84.7% to 96.98%). Conversely, the share of Category II decreased both in terms of the number of items (from 38.6% to 10.34%) and costs (from 14.6% to 3.02%). Category III expenditures (low-priority drugs) were gradually eliminated from the procurement structure, dropping from 3.5% to complete absence in 2024. An increase was observed in the optimization coefficient for Subcategory AV (up to 0.47 in 2023–2024), alongside a growth in the share of expenditures for Group V medicines from 48% to 97%. Subcategories AN and AE were completely eliminated, and the correlation between the shares of medicine items and expenditures became stronger.

Conclusion. In 2022–2024, the procurement structure realigned toward Category I, which is consistent with the principles of evidence-based medicine and the strategic objectives of expenditure optimization while maintaining a high level of therapeutic efficacy.

Background. The search for promising nonsteroidal anti-inflammatory drugs (NSAIDs) is aimed, in particular, at identifying molecules with multitargeted anti-inflammatory and analgesic effects (including through central mechanisms).

Objective: To study the interactions of a candidate NSAID molecule (SV-1010) with opioid receptors and compare them with the effects of known agonist molecules (butorphanol and U-50488) using chemoreactomic analysis and docking.

Material and methods. Chemoreactomic analysis of NSAID mechanisms of action was conducted in three stages: data sampling, establishment of lists of molecules with known properties, and calculation of Kd binding constants and EC50 activation constants. Docking of kappa opioid receptors was performed using MarvinSketch, MOPAC2012, and AutoDock Vina. A comparison of the results of chemoreactomic modeling and docking was performed.

Results. Chemoreactomic analysis of the interactions of the studied molecules with opioid receptors showed that the median and average values ​​of the binding constants Kd of the SV-1010 compound are comparable with the estimates of the constants obtained for butorphanol and U-50488 (75–98 nM for delta receptors, 62–81 nM for kappa receptors, 198–244 nM for mu receptors). Among the studied opioid receptor subtypes, the lowest Kd values ​​were established for SV-1010 for kappa receptors (64.8±46.3 nM; delta and mu receptors: 79.9±77.6 and 243.8±246.9 nM, respectively). No significant difference in the binding of SV-1010 molecules to kappa-1 and kappa-2 opioid receptors was detected (Kd in the range of 23.7–54.5 nM). Docking of the studied molecules into the structure of the human kappa receptor allowed us to obtain Kd values ​​and formulate the mechanism of binding of SV-1010 to the kappa-opioid receptor site (potentially, the key binding amino acids of the kappa-opioid receptor site are ILE730, VAL667, MET579, ILE726, TRP723, ILE460 and TYR464). A comparison of the results of chemoreactomic modeling and docking made it possible to find a correlation expressed by the equation “35.8x – 4790” with a correlation coefficient close to unity. The results of chemoreactome modeling of EC50 constants confirmed the results of the Kd binding constant analysis, including the finding that SV-1010 exhibits greater affinity for kappa receptors than for mu receptors.

Conclusion. Chemoreactomic and docking modeling of the SV-1010 molecule's effects support the hypothesis that this compound may be a kappa-opioid receptor agonist, indicating the potential for experimental and other studies of SV-1010 with a focus on kappa-opioid receptors.

Background. Hemophilia is a rare disease covered by Russia’s federal program for 14 High-Cost Nosologies (HCN), which ensures nationwide access to expensive drug therapies funded from the federal budget. The program currently includes 11 hemophilia drug products; however, the absence of transparent, clinically grounded criteria for selecting among these options in specific clinical scenarios complicates therapeutic decision-making.

Objective: To conduct a systematic review of the clinical effectiveness for hemophilia drugs included in the 14 HCN program and to develop an approach for establishing treatment selection criteria for specific patient groups.

Material amd methods. A literature search was performed in PubMed/MEDLINE and the Cochrane Library. Comparative clinical trials, systematic reviews, and meta-analyses were included. In addition, clinical guidelines for hemophilia and prescribing information for the relevant drugs were analyzed.

Results. The available evidence base is heterogeneous and does not permit a comprehensive comparison of all drugs included in the program. Nevertheless, several patterns in clinical effectiveness and important limitations of the evidence relevant to treatment selection were identified. Based on clinical trial data, clinical guidelines, and prescribing information, a methodological approach for developing drug selection criteria was proposed. This approach incorporates patient models, typical clinical scenarios, and an automated treatment selection algorithm.

Conclusion. The proposed approach may support the standardization of prescribing in hemophilia and can be adapted for other diseases included in the 14 HCN program.

Vulvar cancer, a relatively rare gynecologic oncology condition, remains a pressing issue given its late diagnosis and the significant decline in quality of life following surgery and chemoradiation. A promising approach to improving the quality of medical care for patients with vulvar cancer is the implementation of prehabilitation and rehabilitation programs. Prehabilitation is a set of measures aimed at improving the patients’ physical function and mental state to mitigate the severity of deconditioning, improve treatment outcomes, and enhance their quality of life. Studies conducted to date show that multimodal prehabilitation programs have a positive effect on patients’ functional capacity and both short- and long-term treatment outcomes. The introduction of prehabilitation programs into clinical practice may be an important, undervalued resource for improving the quality of medical care for patients with gynecologic oncology. This review, based on evidence-based medicine, presents current approaches to prehabilitation for patients with vulvar cancer. Particular attention is paid to studies that are currently underway, as their results may advance our understanding of the role of prehabilitation in improving outcomes in gynecologic oncology in real-world clinical practice.